Pulmonary function, blood gases and carbon monoxide diffusing capacity (DL_CO) were investigated in 10 patients with chronic pulmonary emphysema, 10 cases of chronic bronchitis, 10 cases of chronic interstitial lung deseases (ILD) and 10 healthy men, before and 20 minutes after 10mg sublingual administration of nifedipine.
1) Nifedipine did not modify the bronchial smooth muscle tone in the evaluation of maximal expiratory flowvolume curve.
2) Nifedipine induced a decrease in arterial Po₂ and an increase in alveolar-arterial Po₂ difference in all the patients, but no significant changes were observed in healthy volunteers. Patients with both chronic pulmonary emphysema and chronic bronchitis had the same degree of increase in alveolar-arterial Po₂ difference, while patients with ILD had smaller changes compared to patients with chronic obstructive pulmonary disease (COPD). This suggests that there was a difference of responsiveness of pulmonary vessels to nifedipine between ILD and COPD. It may be said that the responsiveness is affected by fixed vascular lesions in patients with ILD.
3) The changes in alveolar-arterial Po₂ difference was correlated with initial arterial Po₂ before administration of nifedipine in 20 patients with COPD. This finding could be explained by the following two hypotheses. (1) There are more pulmonary vessels manifesting hypoxic pulmonary vasoconstriction (HPV) which can be reactive to nifedipine and nifedipine dilates more pulmonary vessels constricted by hypoxia to induce the larger changes in alveolar-arterial Po₂ difference in patients with higher arterial Po₂. (2) A greater decrease in arterial Po₂ may occur in patients whose initial arterial Po₂ is located on the gentle portion of the hemoglobin oxygen-dissociation curve even if the increased volume of venous admixture due to rilief of HPV is the same degree.
4) Reduction in DL_CO was observed in all patients after administration of nifedipine. It may be partially explained by the fact that the effect of nifedipine on redistribution of blood flow to the units with low V/Q without changes in alveolar ventilation is greater than the effect of increased cardiac output on DL_CO.

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Forty cases of bronchial asthma were examined to clarify the relationship between the respiratory threshold of acetylcholine (RT-Ach) and the patterns of flow-volume curve before inhalation of acetylcholine. The patients were divided into 2 groups: 19 patients younger than 12 years and lower than 140cm (younger patient group) and 21 patients of age between 12 and 21, and higher than 140cm (older patient group). The patterns of flow-volume curves were evaluated by the indices of obstructive index, volume index and curve score.
In the younger patient group there were statistically significant relationships between all of these indices and RT-Ach. In the older patient group there were significant relationship between V175 and RT-Ach, V150 and RT-Ach, and OI and RT-Ach, however RT-Ach had no relation to VI25 or CS.
These results may support the view that RT-Ach may be related to airway conditions such as airway obstruction and airway restriction before inhalation of acetylcholine.

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We examined the effect of systemic hypercapnia on hypoxic pulmonary vasoconstriction during one lung ventilation in five dogs with thoracotomy.
The lung was ventilated with 100% oxygen and systemic arterial carbon dioxyde was controlled by changing the ventilatory rates. Aortic and left pulmonary blood flows are electromagnetically measured. The blockade of the left main bronchus resulted in immediate and sustained decrease in the percent left lung blood flow in 15min; from 36±4% to 13±2% in the group with systemic normocapnia and from 33±3% to 24±2% in the group with systemic hypercapnia.
We conclude that systemic hypercapnia significantly masks the effect of one lung hypoxic pulmonary vasoconstriction.

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We applied a tissue spectrum analyzer (Sumitomo Electric Industries, Ltd., Osaka) to human bronchi to examine bronchial mucosal hemodynamics and oxygen consumption during bronchofiberscopic examination. The reflected spectra from the bronchial mucosa of 41 cases of chest diseases were analyzed.
There were no differences in the mucosal blood volume and oxygen saturation of hemoglobin at three different sites in the normal bronchus (carina, bifurcation between the right upper lobe bronchus and the truncus intermedius and that between the left upper lobe and lower lobe bronchi).
On the other hand, the comparison of mucosal blood flow and oxygen saturation between endobronchial nonmalignant inflammatory lesions and malignant lesions revealed significant differences. The blood volume of the normal areas was less than that of both inflammatory lesions and the malignant lesions (p<0.01). However, the oxygen saturation of tissue hemoglobin in the malignant lesions was lower than that of the normal area (p<0.01) which in turn was lower than in inflammatory lesions (p<0.01).
From these results, it was suggested that inflammation caused dilatation of the vessels perhaps through chemical mediators and decreased oxygen consumption of the tissue may be caused by poor cell function. In cancer cases, it seemed that increased blood flow was caused by the increased oxygen demand of the tissue due to the accelerated cell cycle.

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The purpose of this study was to identify in situ localization of P. aeruginosa in the lung of DPB patients by immunofluorescent antibody technique and immunoperoxydase staining procedures using the avidin biotinylated horseradish peroxydase complex (ABC) method.
The lung tissues were obtained by autopsy from three DPB patients who had all been in an advanced stage after a long clinical history.
P. aeruginosa was found extensively not only in the lumen of the airway from segmental bronchus to alveoli, but also in layers of ciliated epithelium, subepithelial tissue, bronchial muscle and cartilage, and in bronchial glands and the lumen of the pulmonary artery. Local response of inflammatory cells to proliferation of P. aeruginosa was minimal in these respective area.
The clinical evidence that the control of P. aeruginosa infection is especially difficult in these patients, is at least partially explainable by the results obtained in the present study.

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Enolase is a glycolytic enzyme and consists of three distinct subunits, α, βand γ. The γ-enolase, that is neuron-specific enolase, was documented to be a tumor marker for neuroendocrine tumors and small cell carcinoma of the lung (SCCL). The purpose of the present paper is to assess the value of γ-enolase as a tumor marker for non-SCCL and SCCL.
Tissue levels of α-enolases (in 46 lung cancers and 13 histologically normal lungs) and serum levels of α- and γ-enolases (in 81 patients with lung cancer, 12 cases with benign pulmonary disease, and 100 healthy controls) were determined with an enzyme immunoassay system, and then the γ/α+γ value was calculated in each tissue and serum sample. Immunohistochemical localizations of α- and γ-enolases were studied in tissues of 30 lung cancers and 10 normal lungs by the direct peroxidase-labeled antibody method using periodate-lysine-paraformaldehyde-fixed, cryostat sections.
Tissue levels of γ-enolase were elevated in non-SCCL and SCCL about 4- and 35-fold, respectively, when compared with the normal lung. Tissue levels of α-enolase in all histological types of lung cancers were also enhanced about 4-fold when compared with the normal lung. Therefore the γ/α+γ value was significantly high only in SCCL (p<0.01).
Serum levels of γ-enolase in healthy controls ranged from 1.5-5.8ng/ml (mean 3.1±0.9ng/ml), and levels greater than 6ng/ml were considered to be positive since this value is almost 3 standard deviations above the mean. Fifteen cases of 63 patients with non-SCCL (mean 5.0±2.9ng/ml) and 14 cases of 18 patients with SCCL (mean 30.0±34.0ng/ml) were positive. Serum levels of α-enolase were elevated almost equally in most of the patients with lung cancer. Therefore the γ/α+γ value was significantly high only in SCCL (p<0.01).
Immunohistochemically the γ-enolase was present in all of 13 squamous cell carcinomas and 12 of 14 adenocarcinomas.
These results indicate that the anaerobic glycolysis is enhanced in all histological types of lung cancers, and the elevated γ-enolase in sera of the patients is probably derived from the tumor tissues. Therefore serum γ-enolase may be a useful marker for staging and monitoring the clinical course of the patients with lung cancer, and γ/α+γ values in serum samples may be useful for the differential diagnosis of SCCL from non-SCCL.

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The method of transfer from oral to aerosol corticosteroids based on the kind of steroid and maintenance dosage was investigated by adding a beclomethasone dipropionate inhaler (BDI) in the treatment of steroid-dependent asthmatic adult patients.
On an average, 75% of steroid maintenance dosage was reduced, controlling clinical symptoms in six patients with an initial daily prednisolone dose of less than 7.5mg (5.4mg/day an average). Although the withdrawal rate of maintenance oral prednisolone dosage was 32% on an average, clinical symptoms were inadequately controlled and the symptom score of attacks during the last month was almost the same as in the control phase in seven patients with an initial daily prednisolone dose of more than 7.5mg (12.1mg/day on a average). In six betamethasone dependent patients of less than 0.75mg initial daily dose (0.51mg/day on a average), reduction of the daily maintenance dose was insufficient for 8 weeks.
Plasma cortisol levels were not increased significantly in all groups. In three steroid withdrawal patients, plasma cortisol levels were normal before BDI treatment or tended to improve in comparison to the control phase.

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The present studies were designed in order to clarify the effects of dialyzer-induced complement activation and dialysate base composition (acetate or bicarbonate) on dialysis-associated hypoxemia.
1) Experiments with human plasma in vitro showed that a cuprophan membrane could activate complement and chemotaxis more than a polymethylmethacrylate (PMMA) membrane.
2) Awake dogs infused by autologous zymosan-activated plasma clearly showed a decrease in pulmonary diffusing capacity (DL_CO) and white blood cell count. The histological examination showed intravascular pulmonary leukostasis. However, the fall in DL_CO did not alter the alveolar-arterial oxygen gradient (P(A-a)O₂).
3) Ten normal volunteers receiving intravenous infusion of Na acetate at 6mmol/min showed no change in consumption of CO₂.
4) Hemodialysis was performed using a cuprophan dialyzer with acetate dialysate and a PMMA dialyzer with acetate or bicarbonate dialysate. The degree of leukopenia and fall in DL_CO with PMMA were less than those with cuprophan. However, the fall in DL_CO did not alter P(A-a)O₂. During acetate dialysis, an average 56ml/min of CO₂ was removed through the extracorporeal dialyzer, and the respiratory quotient dropped. These phenomena did not occur inbicarbonate dialysis. The arterial CO₂ tension did not significantly change throughout dialysis, but the alveolar ventilation decreased significantly in proportion to the fall in carbon dioxide output.
These results indicate that the occurrence of marked leukopenia and decrease in DL_CO in the early period of hemodialysis can be prevented by using a PMMA membrane, which activated total complement less than a cuprophan membrane. However, the dialysis-induced hypoxemia during dialysis with acetate dialysate, but not with bicarbonate, is mainly caused by CO₂ loss via the dialyzer, resulting in reflex hypoventilation.

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A 34 year-old man was admitted with chest pain, hemosputum and fever. On admission physical examination revealed cyanosis of the lips and nails, absolutely irregular pulse, dullness and coarse crackles on the lower portion of the right lung and hepatomegaly. Laboratory data showed mild erythrocytosis, elevated ESR, positive CRP, mild dysfunction and decreased level of %VC. Electrocardiogram showed atrial fibrillation. Chest roentogenogram revealed cardiomegaly, pericardial calcification and homogeneous infiltration shadows. Interestingly, those shadows came and disappeared for short periods.
Perfusion lung scan (99mTc-MAA) revealed diminished uptake over in both lower lungs. On the other hand, ventilation lung scan (133Xe-gas) revealed no diminished uptake in the left lower lung. Computed tomogram of the chest revealed that a giant mass existed in the right atrium. Therefore, the case was diagnosed as pulmonary embolism with infarction due to the right atrial giant mass. Qualitative diagnosis of the right atrial mass could not be completed by use of ultrasonic cardiography or pulmonary angiography. The pericardium was stripped and the right atrial mass was resected. As a result the atrial mass was proved to consist of thrombus. The cause of right atrial thrombus in this case could not be determined. However, it was suggested that pericardial calcification, atrial fibrillation and stress erythrocytosis lead to this disorder.

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A 49 year-old male who had been treated with steroids for rheumatoid arthritis suffered from recurrent pneumothorax and cystic disease of the lung. Low dose prednisolone had been administered for three years. Pnuemothorax occurred three times within the last two years, and also the extent of cystic disease in both lungs increased during the same period. Oral administration of antibiotics was commenced and administration of prednisolone was discontinued after admission, following which the cystic shadow in both lungs decreased in size dramatically.
It has been impossible to establish any close relationship between steroids and lung disease, histologically or biochemically, however the clinical courses of some cases, including the present one, suggest that there is indeed a relationship. We should keep in mind the possibility of clinical disability induced by steroid.

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A 63 year-old woman had been treated with Minocycline (MINO) because of acute pneumonia in the right upper lobe, and had gradually improved. Nine days after the beginning of MINO therapy, she developed dyspnea, a nonproductive cough and a fever. Her chest X-ray film revealed reticulo-nodular shadows in both lower lung fields, and on ausculation, crepitant rales were heard over both lung bases. Once the treatment with MINO was stopped, her complaints, laboratory data and chest X-ray findings improved. Microscopic examination of a transbronchial lung biopsy specimen disclosed alveolar septal thickening, which indicated interstitial pneumonitis. The result of a lymphocyte stimulation test was positive for MIND.
In view of the above, MINO-induced pneumonitis was considered in this case.
To our knowledge, there has been only one previously reported case of MIND-induced pneumonitis, that by Gomi, et al.

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A 44 year-old man was transferred to our hospital on July 17, 1985, for treatment of pneumonia and respiratory failure. He had been hospitalized elsewhere on June 24, 1985, because of fever and dyspnea. He had been treated with several kinds of antibiotics there, but no improvement was noted.
On admission, he appeared cachectic and cyanotic. Four foci of fungal skin infections were found. The arterial oxygen tension with 1.5l/min oxygen by nasal cannula was 30. The white-cell count was 6300, with only 4 per cent lymphocytes. A chest film showed bilateral diffuse infiltration with air bronchogram.
Despite intensive oxygen and antibiotic therapies, the patient's condition deteriorated. A three-day course of high dose methylpredonisolone therapy (1g/day) was also ineffective.
On July 31, bronchial washing performed under ECMO (extracorporeal membrane oxygenation) revealed many cytomegalovirus-inclusion cells and Pneumocystis carinii organisms. On the same day, the patient's colleagues in formed us that the patient had homosexual relationships for more than four years. He lived with a man from New Zealand from 1981 to 1983. In addition, he was a member of the gay community in the Shinjuku area.
The patient died on August 1. An autopsy showed heavy and firm lungs (right 2125g, left 975g) with liver-like appearance on its cut surface. Microscopic examination revealed Pneumocystis carinii pneumonia, cytomegalovirus infection of the lung, adrenal, pancreas, prostate, gastric mucosa, and liver, and Herpes simplex skin infection of the scrotum. There was no evidence of malignancy. Further laboratory examination of the premortem specimens showed the marked decrease in the ratio of the lymphocyte subsets (Leu 3a/Leu 2a=0.09) and the presence of AIDS virus antibody.
Final diagnoses were 1. AIDS 2. Pneumocystis carinii pneumonia 3. Systemic cytomegalovirus infection 4. Tinea corporis due to trichophyton 5. Skin erosion of the scrotum due to Herpes simplex.

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A 23 year-old woman was admitted with fever and sputum. Chest roentgenogram showed infiltrative and multiple nodular shadows in both lungs. Laboratory data showed remarkable eosinophilia (49%, 5047/mm³) and hyperimmunoglobulinemia E (29400u/ml).
Staphylococcus aureus was isolated from sputum expectorated and aspirated through a bronchofiberscope. Because antibiotics such as cephems and penicillins were ineffective, open lung biopsy was performed and revealed pulmonary abcesses due to Staphylococcus aureus.
The case was diagnosed as hyper IgE syndrome with recurrent skin infection of staphylococcus aureus from childhood. Neutrophil function test revealed depressed phagocytic and killing activity against staphylococcus aureus and depressed chemiluminescence, superoxide production and polarization.
Her grandfanther and father have consanguinity and a familial study revealed mild elevation of IgE and depression of chemiluminescence her father. These data suggest the importance of hereditary factors in this case.

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